Asthma and Chronic Migraine
Individuals with asthma who also experience episodic
or occasional migraine may be more likely to develop
chronic migraine, according to a National Headache
Foundation-sponsored study recently published online in
the journal Headache.
“If you have asthma along with episodic or occasional
migraine, then your headaches are more likely to evolve
into a more disabling form known as chronic migraine,”
said Vincent Martin, MD, professor of medicine in
University of Cincinnati’s Division of General Internal
Medicine, co-director of the Headache and Facial Pain
Program at the UC Neuroscience Institute and lead au-
thor in the study. Dr. Martin is President of the National
Headache Foundation.
Researchers from the University of Cincinnati (UC),
Montefiore Headache Center, Albert Einstein College
of Medicine, and Vedanta Research studied 4,500 indi-
viduals who experienced episodic migraine or fewer than
15 headaches per month in 2008. They analyzed data
from the American Migraine Prevalence and Prevention
(AMPP) Study which was undertaken during 2008 and
2009. Study participants completed written question-
naires in both years. Based on responses to the 2008
questionnaire, patients were divided into two groups –
one with episodic migraine and coexisting asthma, and
another with episodic migraine and no asthma. Patients
were questioned about medication usage, depression,
and smoking status. The 2008 and 2009 questionnaires
included questions about frequency of headaches, which
enabled the authors to identify the participants who had
progressed to chronic migraine.
After one year of follow-up, researchers found that
new onset chronic migraine developed in 5.4 percent of
participants who were also suffering from asthma, and in
2.5 percent of individuals without asthma. “The strength
of the relationship is robust,” Martin said. “Asthma was a
stronger predictor of chronic migraine than depression,
which other studies have found to be one of the most
potent conditions associated with future development of
chronic migraine.”
About 12 percent of the U.S. population experiences
migraine, according to Martin. Chronic migraine affects
about 1 percent of the U.S. population and takes a severe
toll on sufferers who often miss work and social events.
There are various theories as to why asthma may have
a predictive role in chronic migraine development for
individuals with episodic or occasional migraine. Martin
said asthmatic patients are more likely to also have al-
lergies and prior studies have shown that allergies may
increase the number of headaches, particularly if the
individual has hay fever.
Other possibilities, according to Martin, include pa-
tients with asthma who may have an overactive parasym-
pathetic nervous system that predisposes them to attacks
of both migraine and asthma. The parasympathetic ner-
vous system is a part of the autonomic nervous system.
It serves to slow the heart rate, increase intestinal and
glandular activity, and relax the sphincter muscles. Dr.
Martin said it is also possible that asthma may not di-
rectly cause chronic migraine, but that a shared environ-
mental or genetic factor, like air pollution – which has
been known to trigger both asthma and migraine attacks
– may play a role.
Dr. Martin suggested that physicians may consider pre-
scribing preventive medications for migraine at an earlier
stage in patients who suffer from asthma and occasional
migraine in order to avoid chronic migraine. “If allergies
are the trigger, it begs the question, should we treat aller-
gies more aggressively in these patients?” said Martin.
The AMPP Study was funded through research grants
to the National Headache Foundation from McNeil-
Janssen Scientific Affairs LLC, Raritan, N.J. The AMPP
study database was donated by the McNeil-Janssen Sci-
entific Affairs LLC to the National Headache Foundation
for use in various projects. HW
1. Cady RK, Durham PL. Chronic migraine:
Diagnosis and management. In: Headache and
Migraine – Biology and Management. Oxford:
Elsevier, 2015; pp 99-122
2. Martin VT, Fanning KM, Serrano D, Buse
DC, Reed ML, Lipton RB. Asthma is a risk
factor for new onset chronic migraine: Results
from the American Migraine Prevalence
and Prevention Study. Headache 2016;
56:118-131.
3. Messina E. Migraine triggers and how to deal
with them. Head Wise 2014; 3:13-15.
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